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Antacids, a Gateway Drug?

Are antacids the gateway drug to chronic PPI therapy?

Are antacids the gateway drug to chronic PPI therapy?

Did you know that 1/3 of Americans suffer from heartburn at least once a month? Nearly every day 10% of Americans have acid reflux. With numbers like that, it’s probably safe to say you know someone with heartburn, even have a friend that carries over the counter antacids like TUMS, Rolaids or Pepcid, in their vehicle, purse or on their person at all times. Antacids are a reasonable and effective remedy for occasional heartburn, however, if you are consuming them daily, or multiple times throughout the day, perhaps it’s time to talk to a physician about other options. Antacids are the gateway drug. Antacids are non-addictive but if you become dependent on them to get through life, most likely there is a bigger problem and a need for further treatment. Perhaps your heartburn has progressed to true GERD (Gastro-Esophageal Reflux Disease). This is defined as persistent troublesome symptoms or actual damage to the esophagus. The most common first step is to begin a short term PPI regiment.

PPIs can be viewed as almost addictive. Not so much in the, I need my Nexium now, hunger for it way, but in that the body could develop temporary rebound acid production. This can lead to worsening stomach upset and symptoms from reflux.

If using the drugs for short period of time it may not be problematic, but they tend to breed dependency, say experts, leading patients to take them for far longer than the recommended 8 to 12 weeks; some stay on them for life.

Hospitals have been known to start patients on P.P.I.’s as a matter of routine, to prevent stress ulcers, then discharging them with instructions to continue the medication at home.  P.P.I.s can be safe when used according to the prescribed indication of up to six months for maintenance, though many physicians prescribe it for longer.

“Studies have shown that once you’re on them, it’s hard to stop taking them,” said Dr. Shoshana J. Herzig of Beth Israel Deaconess Medical Center in Boston. “It’s almost like an addiction.” P.P.I.’s work by blocking the production of acid in the stomach, but the body reacts by overcompensating and, she said, “revving up production” of acid-making cells. “You get excess growth of those cells in the stomach, so when you unblock production, you have more of the acid-making machinery,” she said.

With this in mind it is important to remember PPIs do not cure GERD, they don’t prevent the progression of GERD, they don’t prevent Barrett’s esophagus nor can they prevent or decrease the likelihood of cancer. PPIs only control symptoms.

--Tripp Buckley, MD

If you enjoyed this week's Blog, we think you would enjoy last week's Blog:  If PPIs are so great, why....

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Thanksgiving Tips from Dr. Buckley

Following are some tips from Dr. Buckley to help reduce GERD symptoms: Schedule an earlier meal. It's best not to eat late at night if you suffer from GERD.   Another good idea is to serve lighter appetizers. Fatty foods like chips, dips, and cheeses are slow to empty from the stomach and more likely ...Read More »

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